=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982670964
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPALACHIAN PROSTHETIC & ORTHOTIC SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2006
-----------------------------------------------------
Last Update Date | 11/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3551 E STONE DR
-----------------------------------------------------
City | KINGSPORT
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37660-7115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-288-8599
-----------------------------------------------------
Fax | 423-288-5227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3551 E STONE DR
-----------------------------------------------------
City | KINGSPORT
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37660-7115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-288-8599
-----------------------------------------------------
Fax | 423-288-5227
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY TREASURER
-----------------------------------------------------
Name | MRS. SHARON E WILLIAMS
-----------------------------------------------------
Credential | CO BOCO CPED
-----------------------------------------------------
Telephone | 423-288-8599
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------